Applied Behavioral Analysis is the science of understanding and molding human behaviors. Dr. I. Lovaas utilized Skinner-era techniques in the latter half of the 20th century to produce proven results in selected ASD patients.
Dr. D. Granpeesheh authored a sentinel paper proving that “the most robust gains have been demonstrated when ABA is provided… 30 to 40 hours per week of one-to-one ABA intervention, for 2 or more years, beginning before age 5.” Over the years, ABA has evolved and includes numerous iterations, resulting in varying success rates of improving symptoms such as disruptive, repetitive or non-social behaviors, and communication skills.
ABA, OT, S&L, PT and other professional therapists are best-trained to do the job of helping parents assist recovery in their autistic children. After years of watching the interactions between thousands of parents and children, I feel qualified to offer some of my observations about what should NOT be done, in order to achieve more successful outcomes and avoid further conflict.
- Stop repeating everything. Your child is autistic, not deaf. The more you restate, the more the child may expect you to repeat in order to get a task accomplished. In addition, some echolalia may be due to the speech pattern to which the child has been exposed. “Do you really think so? Do you really think so?”
- Stop raising your voice. What intensity level do you have to achieve until the child listens? A bit louder than the last time, probably. Ditto with physical punishment, especially for children with increased resistance to pain. How forcefully will you have to hit the affected child next time?
- Don’t miss opportunities to encourage speech. At The Child Development Center, we often observe interactions, such as a child visually requesting a cookie, when the parent could have demanded the “K-K-K” sound and initiated some imitation.
- Not all negative behaviors should be ignored. There is a difference between annoying and disruptive. Teeth grinding is annoying. Pulling Mom’s hair while traveling at 60 miles per hour does not go unnoticed. In ABA-speak, such behavior needs to be extinguished. Likewise, aggression against self or others requires active re-direction. Do not make excuses for your child’s disruptive behaviors. “He’s only hitting the therapist /his teacher /the doctor’s staff /etc., because they took away his toy” or, “You made him do something he doesn’t like.” Finally, make sure that you are not dealing with a treatable condition. Often, SIBs are signs of bad cooties, and require medical investigation.
- Do not continue to spend valuable resources on therapists whom your children have outgrown. Signs, such as the child’s reluctance to attend, or defiance toward a previously well-liked individual are important. It’s boring to repeat “Bi-Bi-Bi” for 2 years. In addition, if you think that something doesn’t make sense (e.g., “The child doesn’t have speech apraxia, he just doesn’t want to speak”), challenge their statements and ask if they have ever ‘fixed’ that problem before.
- Do not believe websites advertising miracle cures. Scrutinize the author’s credentials and claims. Telltale signs that you may be wasting your money include full pre-payment, lots of anecdotal stories, music, claims of ‘safe for all’, and clinics in foreign countries. Experimental treatments are just that, and could be harmful, perhaps not immediately; but, unknown problems may arise many years later. Don’t think that you can buy your way out of autism. Just ’cause it’s expensive, doesn’t mean it works.
- Avoid relatives and others who claim that you are parenting incorrectly. Let them spend just 24×7 (or often, much less) in your shoes.
- Do not settle for the advice of conventional doctors who profess that all behaviors are “Just due to the child’s autism.” Poor sleep, eating disorders, abnormal stooling, or obesity may be keys to treatable causes of downstream difficulties. Conversely, it is unacceptable when multiple specialists only choose to see a small piece of the pie, merely treating one symptom, perhaps at the expense of making other conditions worse (e.g., Miralax™ for constipation).
- Don’t give up on biomedical protocols. Any kid can have a bad day, so give it time. Sometimes, with the help of a trusted professional, letting things percolate for a day or even a week may be the best course of action. While on this issue, do not discontinue, or even decrease the traditional treatments, including ABA, S&L, PT, OT, just because you are exploring other avenues for improvement.
- Saying the words, “We have to stop at McDonald’s /the toy store /my mother’s house/etc., or the child will have a fit,” is backward thinking. You are the adult, and you have created that behavior.
- Stimming on YouTube videos and Angry Birds is not a sign of digital intelligence. By the 50th time that a child goes over the same screen, you can safely assume nothing new is being learned and time is being wasted. Rather than admonishing, “Don’t do ‘this or that’ behavior any more,” say “You can do that 3 more times,” or “Two more minutes, etc.” (visual timers can help), and redirect to another activity.
- Do not give your child antibiotics except when absolutely necessary. They don’t kill viruses and viral infections don’t usually “turn into a bacterial one,” unless the illness is exceedingly prolonged and/ or something else amiss (e.g., immunologic deficiency).
- Don’t be your kid’s doctor. You need professional advice.
- Toxins abound in our environment, and the burden may eventually affect susceptible individuals. If, what you are feeding your child has a number in front of it (Red Dye #4), or the word “artificial’, it’s not food, and I don’t care how much he/she enjoys the experience.
- Neuroplasticity is real. No matter how severely affected, nor whatever age, don’t believe that your child cannot improve. So, don’t give up.
Parents, I know that you are doing the best for each and every one of your children. This is just some friendly advice to help streamline their developmental burden.
What a wonderful synopsis on treating the “whole child”! To acknowledge environmental conditions AS WELL AS as biomedical conditions as major factors in behavior is refreshing. I often hear people refer to “autistic behaviors” as if they are a permanent and unchangeable feature of a person diagnosed with an ASD. In reality, behaviors can be viewed more as symptoms: biomedical symptoms or symptoms of the reinforcements in the child’s environment. As I reread this list, it occurs to me that each point would make an excellent chapter title of a book mirroring the article title.
Thanks for reading. My wife would really like your comments, as in, “Why don’t you write a book?”
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I came across your website via a search engine. Do doctors make home visits before diagnosis? We took our great-grandchild, 3 years old, to a pediatrician in North Platte, NE to see why she isn’t speaking. They said that we had to go through our local school. Now, we’ve been notified that the doctors (?) are coming out to our house to observe her interaction to her environment. Is this normal?
We require an in-person visit prior to starting care. Any means of seeing the patient (AND really examining- touching) seems helpful.